Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.34 - Therapeutic Behavioral Services
Section 10.09.34.01 - Definitions
Universal Citation: MD Code Reg 10.09.34.01
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Behavioral plan" means an individualized
written plan for therapeutic behavioral services which includes the components
specified in Regulation .03B(1) of this chapter.
(2) "Department" means the Department of
Health and Mental Hygiene, the single State agency designated to administer the
Medical Assistance Program under Title XIX of the Social Security Act,
42 U.S.C. § 1396(a) -(v).
(3) "Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) provider" means any health care provider acting within
the scope of the provider's practice who:
(a)
Screens, evaluates, or identifies a condition; and
(b) Recommends treatment.
(4) "Medically necessary" means
that the service or benefit is:
(a) Directly
related to diagnostic, preventive, curative, palliative, rehabilitative, or
ameliorative treatment of an illness, injury, disability, or health
condition;
(b) Consistent with
current accepted standards of good medical practice;
(c) The most cost efficient service that can
be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
consumer, family, or provider.
(5) "Participant" means an individual who is
certified as eligible for and is receiving Medical Assistance
benefits.
(6) "Preauthorization"
means the approval required from the Department, or its designee, before
services may be rendered.
(7)
"Prescribed" means ordered in writing and signed by an EPSDT provider who has
examined the participant and diagnosed the participant's medical
condition.
(8) "Program" means the
Maryland Medical Assistance Program.
(9) "Rehabilitative service" means a medical
or remedial service prescribed by a licensed physician or authorized
practitioner under Health Occupations Article, Annotated Code of Maryland, or
the jurisdiction where services are rendered for:
(a) Maximum reduction of physical or mental
disability; and
(b) Restoration of
a participant's best possible functional level.
(10) "Therapeutic behavioral aide" means an
individual who is:
(a) A health care
professional or a nonprofessional who is supervised by an individual who is
licensed, certified, or otherwise legally authorized to provide mental health
services independently in the state where the service is rendered;
(b) Trained and supervised by a therapeutic
behavioral service provider to implement a behavior plan; and
(c) Available on-site to provide one-to-one
behavioral assistance and intervention to accomplish outcomes specified in the
behavioral plan.
(11)
"Therapeutic behavioral assessment" means a comprehensive assessment of a
participant and, if applicable, a participant's family that:
(a) Is performed by a licensed or certified
health care professional;
(b)
Addresses the medical and behavioral needs for therapeutic behavioral
services;
(c) Includes the risk of
needing placement in a more restrictive living arrangement because of the
behavior; and
(d) Includes
development of a behavioral plan.
(12) "Therapeutic behavioral service" means
an intensive, rehabilitative service that is documented in the written
behavioral plan and is intended to:
(a)
Provide the participant with behavioral management skills to effectively manage
the behaviors or symptoms that place the participant at risk for a higher level
of care; and
(b) Restore the
participant's previously acquired behavior skills and enable the participant to
develop appropriate behavior management skills.
(13) "Therapeutic behavioral service
provider" means:
(a) A Developmental
Disabilities Administration provider meeting criteria set forth in COMAR
10.22.02;
(b) An outpatient mental
health clinic approved under COMAR 10.21.20;
(c) A mental health mobile treatment unit
meeting criteria set forth in COMAR 10.09.59; or
(d) A psychiatric rehabilitation program
approved under COMAR 10.21.29.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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